Provider Demographics
NPI:1992332357
Name:THOMAS, MICHELLE L (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 YOUNGSTOWN KINGSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9717
Mailing Address - Country:US
Mailing Address - Phone:330-720-2233
Mailing Address - Fax:
Practice Address - Street 1:5702 YOUNGSTOWN KINGSVILLE RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9717
Practice Address - Country:US
Practice Address - Phone:330-720-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH263167163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health